Randomised Comparative Study between C-MAC D Blade and McCoy Blade Laryngoscope for Intubation with Manual Inline Axial Stabilisation

Abstract

Introduction: Patients with suspected cervical spine fracture or cervical pathology, utmost care has to be taken while intubating these patients to prevent further cervical cord injury. Protective measures include application of rigid collar, a forehead tape and manual inline stabilisation. Application of these manoeuvres reduces the cervical spine movement, making it more difficult to intubate. Aim: To compare the performance of McCoy blade with C-MAC D blade for endotracheal intubation in patients with simulated cervical spine injury. Materials and Methods: One hundred and twenty adult patients were randomly allocated into two groups to achieve tracheal intubation with McCoy (group M=sixty patients), or C-MAC D video laryngoscopes (group C=sixty patients). The ASA patients of grade I-II undergoing elective surgery for having immobilised cervical spine using manual inline axial cervical spine stabilisation technique were enrolled in the study. Patient’s Comparative data on the total time to intubate (Z-test), CormackLehane (CL) laryngoscopic view (Chi-Square test), number of optimising manoeuvres (Yate’s corrected Chi-Square test) and haemodynamic variables (Z-test) were recorded in both groups. Results: The time taken for tracheal tube insertion was significantly longer with C-MAC D blade group of thirty eight seconds compared with McCoy blade group which was thirty one seconds. There was an increase in heart rate at first and second minute in both the groups which returned back to normal after five minutes. Good grade glottic visualisation was obtained with both the laryngoscopic blades. Conclusion: C-MAC D blade as well as McCoy blade forms an effective tool for the airway management of suspected cervical spine injured patients with cervical immobilisation.

Keywords

• cervical immobilisation
• haemodynamic changes
• resuscitation